Vein surgery | Doctors & treatment information

What are veins?

Veins are the blood vessels that carry blood from the legs and organs of the body back to the heart. The transportation of blood from the legs upwards is particularly difficult as it takes place against the force of gravity. This is the reason why venous diseases usually occur in the legs and much less frequently in the arms.

What venous diseases are there?

The most common venous diseases include

• Spider veins
• varicose veins
• venous thrombosis
• Vein inflammation
• Open leg

Below you can find out about the special features of venous diseases and surgical treatment methods.

Venous diseases that require surgery

Varicose veins (varices) are enlarged veins that develop when the venous valves no longer function properly @ gballgiggs /AdobeStock

What are spider veins?

Spider veins are common and patients usually find them aesthetically unpleasant. They are not usually critical for health. Spider veins are most commonly found in the hollow of the knee, on the lower leg and in the ankle region. The slightly enlarged, small, superficial veins shimmer bluish or reddish through the skin. Patients have spider veins due to venous congestion, in some cases there is also a predisposition (genetic predisposition).

Patients with spider veins are predominantly women. However, it is also possible that men suffer less from them and therefore consult a doctor less frequently.

Spider veins are generally harmless and do not cause any discomfort @ zigres /AdobeStock

What is venous thrombosis?

In medical terms, venous thrombosis is the blockage of a vein by a thrombus (blood clot). Most thrombi form in the deep veins of the legs and lead to sudden leg swelling.

In rare cases, deep vein thrombosis leads to a serious circulatory disorder in the leg. The opposite is the sudden occlusion of an artery.

Nevertheless, deep vein thrombosis can be dangerous. This is because the blood clot can detach at any time and cause a vascular occlusion (embolism) elsewhere in the body. For example, in the lungs (= pulmonary embolism).

Venous thrombosis is caused by long car or plane journeys where people are unable to move their legs properly. However, major surgical procedures can also be a cause, such as an artificial joint replacement.

Other triggering factors are

• Vascular inflammation
• Impaired blood clotting
• Hormonal changes in the female body due to hormone treatment (menopause), taking the contraceptive pill and pregnancies.

If a deep leg vein is affected, the calf may swell and hurt, be sensitive to touch and hot @ Анна Богатырева /AdobeStock

What is phlebitis?

In phlebitis, a superficial and rarely deeper vein is affected. The blood vessel leading to the heart is thicker than the healthy veins due to the blood clot. It can therefore be clearly felt.

Phlebitis is always painful. You should therefore have it treated quickly. The skin on the affected area is red and hot.

Causes of phlebitis are

• Clothing that is too tight
• Accumulated blood in the legs and
• Impaired blood clotting

Phlebitis is also problematic because it often forms blood clots. Conversely, thrombosis can cause phlebitis. The treatment of phlebitis depends on whether deep or subcutaneous blood vessels are affected.

What are varicose veins?

Varicose veins (varices, varicosis, varicosis) are pathologically altered, superficial leg veins that appear in the form of nodular , thickened, bluish veins that protrude clearly under the skin.

The large and small saphenous veins (saphenous vein magna/parva) and their branches are affected. Varicose veins sometimes manifest themselves with severe pain, heavy legs and a feeling of warmth in the lower extremities.

As the disease progresses, swelling (oedema) develops. As the blood builds up in the varicose veins, the patient's legs are undersupplied with nutrients and oxygen.

The removal of waste products from the tissue is also restricted. This leads to skin inflammation (eczema). The main cause of varicosis is a genetically determined weakness of the connective tissue.

What is an open leg (leg ulcer)?

A venous leg ulcer (leg ulcer) occurs when thrombosis and/or varicose veins prevent the blood from draining away. It backs up massively in the tissue.

This results in significantly increased tissue pressure, which means that the inflow of oxygen- and nutrient-rich blood is no longer possible. It initially manifests itself as a thickened lower leg and reddish-brownish discolored skin. The hardened skin surface causes pain.

The congestion and the lack of oxygen and nutrients cause wounds to develop and no longer heal. This is called an ulcer. The wound caused by the ulcer is deep and usually heals poorly. If left untreated, an "open leg" can cause life-threatening circulatory problems.

Ulcus cruris (open leg) is a deep and poorly healing wound, usually on the lower leg @ kittyfly /AdobeStock

What vein operations are there?

The most common vein operations are for varicose veins (varicose veins). There are several options available for this:

• Vein stripping

In the "classic operation" (stripping), doctors expose the diseased vein sections at both ends with skin incisions. By inserting a metal probe, they pull out the part in between.

Vein stripping can also be carried out using a cold probe (cryotherapy): The varicose vein freezes on the special probe and can then be removed without any problems.

If there are dilated connecting veins, ultrasound devices can visualize and mark them. The doctor then makes a small incision at the marked area and pulls it out.

• Vein sclerotherapy

During sclerotherapy (vein sclerotherapy) , the doctor injects an anti-inflammatory agent in liquid or foamed form into the varicose veins. He then compresses the varicose veins from the outside, causing the vessel walls to stick together and close.

After the medical procedure, the patient must wear compression stockings for 2-4 weeks.

• Laser therapy

In laser therapy, doctors insert a thin laser probe into the affected varicose vein. The laser energy generates heat in the vein, which irritates the vein walls and causes them to stick together. The operation is performed on an outpatient basis and under local anesthetic. Compression treatment is also required after laser surgery.

• Radio wave therapy

Radio wave therapy works in a similar way. Again, doctors insert a probe into the vein. The heat causes the vein walls to stick together.

• The balloon catheter

Surgical treatment can also be useful in some cases of venous thrombosis. Several procedures are suitable for this, such as the balloon catheter.

If a blood clot has lodged in the affected vessel, doctors insert a balloon catheter via the groin vein. They then inflate the balloon and withdraw it. This allows them to remove the clot.

• Surgery for leg ulcers

Ulcus cruris also requires surgery in certain cases. This is the case if the affected tissue on the leg is very hardened or extremely scarred.

Doctors clean the ulcer under general anesthesia and remove all broken (necrotic) tissue. They then cover the wound with a suitable piece of the patient's skin (usually from the thigh).

Sclerotherapy may also be necessary at the site of the ulcer. This is carried out using laser technology.

After the surgical procedure, it is important to treat the existing infection with special wound dressings and medication. Antibiotics are rarely necessary. In fact, they should be avoided. Otherwise there is a high risk of resistant germs developing.